Biologic medications have revolutionized the treatment of psoriasis. They are powerful drugs that can produce dramatic results and, though they carry a slight increased risk of infection, they have very few everyday side effects. For some psoriasis patients, the main downside of biologics is the delivery method: They need to be injected.
Injections can produce pain, bruising, swelling, redness, and itchinessall of which can be a nuisance for psoriasis patients who need to inject themselves once or twice a week. Patients who are new to biologics may also find themselves confronting a bit of anxiety.
“The first three months were really scary for me,” says Karen, 50, of Milton, Mass., who started taking a biologic in late 2003. “It was the fear of the unknownand I hated needles. I was a huge needlephobe.” After getting used to the process, Karen was injecting herself twice a week with ease.
Until pharmaceutical companies develop a biologic that is taken orallyand at least one is currently in the pipeline, working its way toward FDA approvalinjections are a fact of life for many psoriasis patients. Heres a guide to making the process as painless and stress-free as possible.
Pick your delivery method
Biologics are available in three formats: a do-it-yourself kit in which the drug has to be mixed and the syringe loaded manually, a prefilled syringe, and a penlike auto-injector. All three are injected under the skin, usually in an area with some fat, such as the stomach, the back of the upper arms, or the legs.
Patients may want to experiment to find out which delivery method is most comfortable for them. Each has its own advantages. The mix-it-yourself version is the most time consuming, but it has a finer needle than the prefilled syringe. The auto-injector is the fastest, but its also the hardest to control and is more likely to cause bruising.
Nikki Woistman, 21, of St. Petersburg, Fla., has taken biologics in all three forms. She has never really minded injectionsbut she does find the auto-injector a bit unnerving. “The anticipation of the shot and pushing the buttonit just freaks me out. If Im injecting myself, I can see when its breaking the skin, so I can prepare myself for that initial pain.”
Whatever the method, patients usually take their first dose at a dermatologists office, where a nurse walks them through the process. (In some cases, the pharmaceutical companies who manufacture the drugs may provide in-home training.)
“Its really a pretty simple injection,” says Kathy Kavlick, RN, community outreach nurse for the Murdough Family Center for Psoriasis in Cleveland. “Most people are fine after that first injection and are able to do it on their own at home.”
5 tips for easier injecting
- Wash your hands and swab the injection site with alcohol. (Allow the alcohol to dry to reduce the sting when the needle goes in.)
- Use a new injection site each time to minimize irritation.
- Ice the site for a few minutes before and after the shot to prevent pain and tenderness.
- After injecting, gently massage the area.
- With prefilled syringes that need to be refrigerated, remove the shot 30 minutes before you will use it; letting it come to room temperature lessens the sting.
Managing injection-site reactions
One of the most common complications of biologics is the skin irritation known as injection-site reactions, which Kavlick says can result from the alcohol used to swab the site, preservatives in the medication, or the needle itself. These are itchy, red welts on the skin that surround the injection site and usually disappear in a few days to a week. They tend to occur early on in treatment and then stopbut every patients experience is different. “Theres really no way to predict or prevent them,” says Kavlick.
When Karen started taking a biologic, she didnt have an injection-site reaction for the first three months. After that, however, they never went away. “I had injection-site reactions each and every time,” she says. “They were red, raised welts. Some were the size of a quarter; some were the size of the palm of my hand or bigger.”
Kavlick recommends a topical Benadryl cream or gel or a mild cortisone cream to help relieve the itchiness. But she says psoriasis patients should consult their dermatologist before using cortisone.
There will be a learning curve
Like anything else, injecting yourself with biologics takes some getting used to. If the first few weeks seem daunting, just remember that you will soon be as much of an expert as Karen.
“Before, Id wash my hands 10 times, wipe the counter down with bleach, and set everything up like I was about to operate on somebody,” she says. “But I got to the point where I could just walk into the kitchen, wash my hands, mix it, and shoot it.”